What Is Bipolar Disorder?
People who have bipolar disorder can have periods in which they feel overly happy and energized and other periods of feeling very sad, hopeless, and sluggish. In between those periods, they usually feel normal. You can think of the highs and the lows as two "poles" of mood, which is why it's called "bipolar" disorder.
The word "manic" describes the times when someone with bipolar disorder feels overly excited and confident. These feelings can also involve irritability and impulsive or reckless decision-making. About half of people during mania can also have delusions (believing things that aren't true and that they can't be talked out of) or hallucinations (seeing or hearing things that aren't there).
"Hypomania" describes milder symptoms of mania, in which someone does not have delusions or hallucinations, and their high symptoms do not interfere with their everyday life.
The word "depressive" describes the times when the person feels very sad or depressed. Those symptoms are the same as those described in major depressive disorder or "clinical depression," a condition in which someone never has manic or hypomanic episodes.
Most people with bipolar disorder spend more time with depressive symptoms than manic or hypomanic symptoms.
Bipolar Disorder Types
There are a few types of bipolar disorder, including:
Bipolar I disorder: With this type, you have extreme erratic behavior, with manic “up” periods that last at least a week or are so severe that you need medical care. There are also usually extreme “down” periods that last at least 2 weeks.
Bipolar II disorder: With this type, you also have erratic highs and lows, but it isn’t as extreme as bipolar I.
Cyclothymic disorder: This type involves periods of manic and depressive behavior that last at least 2 years in adults or 1 year in children and teens. The symptoms aren’t as intense as bipolar disorder I or bipolar disorder II.
With any type of bipolar disorder, misuse of drugs and alcohol use can lead to more episodes. Having bipolar disorder and alcohol use disorder, known as “dual diagnosis,” requires help from a specialist who can address both issues.
Bipolar Disorder Symptoms
In bipolar disorder, the dramatic episodes of high and low moods do not follow a set pattern. Someone may feel the same mood state (depressed or manic) several times before switching to the opposite mood. These episodes can happen over a period of weeks, months, and sometimes even years.
How severe it gets differs from person to person and can also change over time, becoming more or less severe.
Symptoms of mania ("the highs"):
Excessive happiness, hopefulness, and excitement
Sudden changes from being joyful to being irritable, angry, and hostile
Rapid speech and poor concentration
Increased energy and less need for sleep
Unusually high sex drive
Making grand and unrealistic plans
Showing poor judgment
Drug and alcohol abuse
Becoming more impulsive
Less need for sleep
Less of an appetite
Larger sense of self-confidence and well-being
Being easily distracted
During depressive periods ("the lows"), a person with bipolar disorder may have:
Loss of energy
Feelings of hopelessness or worthlessness
Not enjoying things they once liked
Less of a sex drive
Inability to feel pleasure
Trouble making decisions
Needing more sleep
Appetite changes that make you lose or gain weight
Thoughts of death or suicide
Bipolar Disorder Causes
There is no single cause of bipolar disorder. Researchers are studying how a few factors may lead to it in some people.
For example, sometimes it can simply be a matter of genetics, meaning you have it because it runs in your family. The way your brain develops may also play a role, but scientists aren’t exactly sure how or why.
Bipolar Disorder Risk Factors
When someone develops bipolar disorder, it usually starts when they're in late adolescence or young adulthood. Rarely, it can happen earlier in childhood. Bipolar disorder can run in families.
Men and women are equally likely to get it. Women are somewhat more likely than men to go through "rapid cycling," which is having four or more distinct mood episodes within a year. Women also tend to spend more time depressed than men with bipolar disorder.
Bipolar disorder usually develops later in life for women, and they’re more likely to have bipolar disorder II and be affected by seasonal mood changes.
A combination of medical and mental issues is also more common in women. Those medical issues can include thyroid disease, migraine, and anxiety disorders.
Some things that make you more likely to have bipolar disorder include:
Having a family member with bipolar disorder
Going through a time of high stress or trauma
Drug or alcohol abuse
Certain health conditions
Many people with the condition abuse alcohol or other drugs when manic or depressed. People with bipolar disorder are more likely to have seasonal depression, co-existing anxiety disorders, posttraumatic stress disorder, and obsessive-compulsive disorder.
Bipolar Disorder Diagnosis
If you or someone you know has symptoms of bipolar disorder, talk to your family doctor or a psychiatrist. They will ask questions about mental illnesses that you, or the person you're concerned about, have had, and any mental illnesses that run in the family. The person will also get a complete psychiatric evaluation to tell if they have likely bipolar disorder or another mental health condition.
Diagnosing bipolar disorder is all about the person's symptoms and determining whether they may be the result of another cause (such as low thyroid or mood symptoms caused by drug or alcohol abuse). How severe are they? How long have they lasted? How often do they happen?
The most telling symptoms are those that involve highs or lows in mood, along with changes in sleep, energy, thinking, and behavior.
Talking to close friends and family of the person can often help the doctor distinguish bipolar disorder from major depressive disorder or other psychiatric disorders that can involve changes in mood, thinking, and behavior.
Diagnosing bipolar disorder can be trickier for children and teenagers. Their symptoms may be the same as adults but might be confused for attention deficit hyperactivity disorder (ADHD) or even just bad behavior.
If you think your child might have bipolar disorder, ask your doctor for a referral to a child psychologist who’s familiar with bipolar disorder.
Bipolar Disorder Treatments
Bipolar disorder can be treated. It's a long-term condition that needs ongoing care. People who have four or more mood episodes in a year, or who also have drug or alcohol problems, can have forms of the illness that are much harder to treat.
Medication is the main treatment, usually involving the following:
Antidepressant-antipsychotic drugs, a combination of an antidepressant and a mood stabilizer
Anti-anxiety medications or sleep medicines, such as sedatives like benzodiazepines
It can take a while to find the right combination for you. You may need to try a few things before you and your doctor figure out what works best. Once you do, it’s important to stay on your medication and talk with your doctor before stopping or changing anything.
Women who are pregnant or breastfeeding should talk with their doctors about medications that are safe to take.
Psychotherapy, or "talk therapy," is often recommended, too. There are several different types. Options can include:
Interpersonal and social rhythm therapy (ISPRT). This is based on the idea that having a daily routine for everything, from sleeping to eating, can help keep your mood stable.
Cognitive behavioral therapy (CBT). This helps you replace bad habits and actions with more positive alternatives. It also can help you learn to manage stress and other negative triggers.
Psychoeducation. Learning more and teaching family members about bipolar disorder can help give you support when episodes happen.
Family-focused therapy. This sets up a support system to help with treatment and helps your loved ones recognize the beginning of an episode.
Other treatment options for bipolar disorder can include:
Electroconvulsive therapy (ECT). Small doses of electricity shock the brain and set off a small seizure to kind of reboot it and change the balance of certain chemicals. While it’s still a last-resort treatment when medications and therapy haven’t worked, it is much better controlled and safer, with fewer risks and side effects, than in the early days of this procedure.
Acupuncture. There’s some evidence that this complementary therapy may help with the depression caused by bipolar disorder.
Supplements. While some people take certain vitamin supplements to help with the symptoms of bipolar disorder, there are many possible issues with using them. For example, their ingredients aren’t regulated, they can have side effects, and some can affect how prescribed medications work. Be sure to tell your doctor about any supplements you take.
Lifestyle changes may also help:
Get regular exercise.
Stay on a schedule for eating and sleeping.
Learn to recognize your mood swings.
Get support from friends or groups.
Keep a symptom journal or chart.
Learn to manage stress.
Find healthy hobbies or sports.
Don’t drink alcohol or use recreational drugs.
Bipolar Disorder Outlook
For most people, a good treatment program can stabilize their moods and help ease symptoms. Those who also have a substance abuse problem may need more specialized treatment.
Ongoing treatment is more effective than dealing with problems as they come up.
The more you know about your condition, the better you can manage your episodes. And support groups, where you can talk with people who are going through the same things you are, can also help.
Bipolar Disorder and Suicide
Some people who have bipolar disorder may become suicidal.
Learn the warning signs and seek immediate medical help for them:
Depression (changes in eating, sleeping, activities)
Talking about suicide, hopelessness, or helplessness
Taking more risks
Having more accidents
Abusing alcohol or other drugs
Focusing on morbid and negative themes
Talking about death and dying
Crying more, or becoming less emotionally expressive
Giving away possessions